Provider Demographics
NPI:1285631390
Name:KAIN, LAURA JEAN (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:KAIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 EDGEWOOD RD SW UNIT 110
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-3390
Mailing Address - Country:US
Mailing Address - Phone:319-390-4144
Mailing Address - Fax:
Practice Address - Street 1:2315 EDGEWOOD RD SW UNIT 110
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404
Practice Address - Country:US
Practice Address - Phone:319-390-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2019-03-25
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
COOPT.0001958152W00000X
IA02194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicare PIN
IAU66544Medicare UPIN